Healthcare Provider Details

I. General information

NPI: 1477629665
Provider Name (Legal Business Name): SCOTT A EDMUNDSON R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 CAVITT AVE
TRAFFORD PA
15085-1065
US

IV. Provider business mailing address

312 CAVITT AVE
TRAFFORD PA
15085-1065
US

V. Phone/Fax

Practice location:
  • Phone: 412-372-5493
  • Fax: 412-372-9543
Mailing address:
  • Phone: 412-372-5493
  • Fax: 412-372-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP041059L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP410571L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: